Guam can require in-person visits for abortion pill, says appeals court

Last week, a federal appeals court reinstated a Guam law requiring an in-person consultation for women seeking abortion. The court’s decision provides further protections for women, who will no longer be able to access abortion by telemedicine.

In 2012, Guam passed a law that required women to meet with a doctor 24 hours before any abortion. After the territory’s last abortionist retired in 2018, the law unofficially halted abortions on the island. Two Hawaiian abortionists then challenged the in-person consultation, arguing that they should be able to prescribe the abortion pill via telemedicine. In 2021 the court placed an injunction on that requirement, thereby allowing dangerous chemical abortions without the direct oversight of a physician.

In the ruling, which overturned the lower court’s decision, U.S. Circuit Judge Kenneth Lee wrote that the territory’s law should be upheld because “the people’s representatives – not judges – decide whether to allow, ban, or regulate abortions.”

“Guam can enact laws that it believes are best for its people, even if some people might strenuously oppose such laws or think them unwise,” Lee wrote.

The court ruling also underscored the importance of an in-person examination for the abortion procedure.

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“Guam has legitimate interests in requiring an in-person consultation,” the judges said. “The consultation can underscore the medical and moral gravity of an abortion and encourage a robust exchange of information.”

Telemedicine abortion allows an abortionist to prescribe the abortion pill without ever examining the woman. Without a prior exam, a potentially fatal ectopic pregnancy could go undiagnosed. In addition, the abortion pill is only approved for use through 10 weeks of pregnancy, but this requirement cannot be enforced if a doctor does not first confirm the gestational age of the preborn child. If the woman taking the abortion pill is Rh-negative but goes undiagnosed, her future pregnancies may be put at risk.

The abortion pill has been found to be four times more dangerous than first-trimester surgical abortion. If a woman suffers complications from the abortion pill, she is nearly 4,000 miles away from the Hawaiian abortionist who prescribed her the drugs.